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what are the best treatment options for stage 3 uterine prolapse, cystocele, and rectocele?

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I am a 28 year old who gave birth to my first child 8 months ago. After a complicated delivery I am left with stage 2 to 3 uterine prolapse, rectocele, and cystocele. My symptoms are very mild and do not interfere with any of my daily activities, except that my cervix falls down when I do anything strenuous. I have an appointment with my gyno this week, but would like to have more information about treatment options before I see her. I have done some research and it looks like some of the options are: vaginal pessary, hysterectomy (not doing this!), and a surgery that can suspend your uterus using your own tissue, and/or with mesh. My main concern is that I want to have more children and don't know if this is possible in my current state or after a repair. I also can't find a lot of good information about pessaries or what it is like to wear one. Any help/advice/insight would be greatly appreciated.

Hi indymom,
Thank you for your question and welcome to Empowher. Uterine prolapse is very common after having a baby vaginally. Your womb can sag or move out of place and this is why you can feel it ‘slipping’ when you do anything strenuous. You are correct about the corrective actions that you wrote about. Let’s take a look at each one.

Non-surgical options
Exercise – Special exercises, called Kegel exercises, can help strengthen the pelvic floor muscles. This may be the only treatment needed in mild cases of uterine prolapse. To do Kegel exercises, tighten your pelvic muscles as if you are trying to hold back urine. Hold the muscles tight for a few seconds and then release. Repeat 10 times. You may do these exercises anywhere and at any time (up to four times a day).

Vaginal pessary – A pessary is a rubber or plastic doughnut-shaped device that fits around or under the lower part of the uterus (cervix), helping to prop up the uterus and hold it in place. A health care provider will fit and insert the pessary, which must be cleaned frequently and removed before sex.

Estrogen replacement therapy (ERT) – Taking estrogen may help to limit further weakness of the muscles and other connective tissues that support the uterus. However, there are some drawbacks to taking estrogen, such as an increased risk of blood clots, gallbladder disease and breast cancer. The decision to use ERT must be made with your doctor after carefully weighing all of the risks and benefits.

Surgical options

Hysterectomy – Uterine prolapse may be treated by removing the uterus in a surgical procedure called hysterectomy. This may be done through an incision made in the vagina (vaginal hysterectomy) or through the abdomen (abdominal hysterectomy). Hysterectomy is major surgery, and removing the uterus means pregnancy is no longer possible.

Uterine suspension – This procedure involves putting the uterus back into its normal position. This may be done by reattaching the pelvic ligaments to the lower part of the uterus to hold it in place. Another technique uses a special material that acts like a sling to support the uterus in its proper position. Recent advances include performing this with minimally invasive techniques and laparoscopically (through small band aid sized incisions) that decrease post operative pain and speed recovery.

Here is one of our articles that may be helpful also http://www.empowher.com/vaginal-prolapse/content/vaginal-prolapse-what-are-surgical-treatment-options-dr-cornella.

I hope this information helps. Can you please keep us updated on what your choice? You may be able to help other women by sharing your story. Good luck.

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